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A Cluster of Cases of Nosocomial Legionnaires Disease Linked to a Contaminated Hospital Decorative Water Fountain

Published online by Cambridge University Press:  02 January 2015

Tara N. Palmore ,
Frida Stock ,
Margaret White ,
MaryAnn Bordner ,
Angela Michelin ,
John E. Bennett ,
Patrick R. Murray  and
David K. Henderson
Tara N. Palmore*
Affiliation:
Warren Grant Magnusen Clinical Center, National Institutes of Health, Bethesda, Maryland National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
Frida Stock
Affiliation:
Warren Grant Magnusen Clinical Center, National Institutes of Health, Bethesda, Maryland
Margaret White
Affiliation:
Warren Grant Magnusen Clinical Center, National Institutes of Health, Bethesda, Maryland
MaryAnn Bordner
Affiliation:
Warren Grant Magnusen Clinical Center, National Institutes of Health, Bethesda, Maryland
Angela Michelin
Affiliation:
Warren Grant Magnusen Clinical Center, National Institutes of Health, Bethesda, Maryland
John E. Bennett
Affiliation:
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
Patrick R. Murray
Affiliation:
Warren Grant Magnusen Clinical Center, National Institutes of Health, Bethesda, Maryland
David K. Henderson
Affiliation:
Warren Grant Magnusen Clinical Center, National Institutes of Health, Bethesda, Maryland
*
National Institutes of Health, 10 Center Dr., Room 11N234, MSC 1888, Bethesda, MD 20892-1888 (tpalmore@mail.nih.gov)
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Abstract

Background.

Nosocomial outbreaks of Legionnaires disease have been linked to contaminated water in hospitals. Immunocompromised patients are particularly vulnerable and, when infected, have a high mortality rate. We report the investigation of a cluster of cases of nosocomial pneumonia attributable to Legionella pneumophila serogroup 1 that occurred among patients on our stem cell transplantation unit.

Methods.

We conducted a record review to identify common points of potential exposure, followed by environmental and water sampling for Legionella species from those sources. We used an air sampler to in an attempt to detect aerosolized Legionella and pulsed-field gel electrophoresis to compare clinical and environmental isolates.

Results.

The most likely sources identified were the water supply in the patients' rooms and a decorative fountain in the radiation oncology suite. Samples from the patients' rooms did not grow Legionella species. Cultures of the fountain, which had been restarted 4 months earlier after being shut off for 5 months, yielded L. pneumophila serogroup 1. The isolates from both patients and the fountain were identical by pulsed-field gel electrophoresis. Both patients developed pneumonia within 10 days of completing radiation therapy, and each reported having observed the fountain at close range. Both patients' infections were identified early and treated promptly, and both recovered.

Conclusions.

This cluster was caused by contamination of a decorative fountain despite its being equipped with a filter and ozone generator. Fountains are a potential source of nosocomial Legionnaires disease despite standard maintenance and sanitizing measures. In our opinion, fountains present unacceptable risk in hospitals serving immunocompromised patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 8 , August 2009 , pp. 764 - 768
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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